Fibromyalgia

Around 1 in 25 of the UK population has fibromyalgia, a lifelong condition involving widespread musculoskeletal pain and tenderness, fatigue, sleep disturbance, and functional impairment, without any known structural or inflammatory cause (Annemans 2008; Hauser 2008; De Silva 2010; Burckhardt 1994). This problem is costly in terms of consultations, prescriptions and sick leave (Annemans 2008; Busch 2007; Boonen 2005; Hauser 2010).

In fibromyalgia, abnormalities in central pain-processing and the release of neurotransmitters including serotonin and noradrenaline lead to lower pain thresholds (Holman 2005; Clauw 2008). Predisposing factors for the condition include female gender, anxiety, trauma and viral infection (Clauw 2009). American College of Rheumatology diagnostic criteria for fibromyalgia are widespread pain lasting at least 3 months, affecting both sides of the body, above and below the waist; plus pain at 11 or more of 18 designated possible tender points, when 4kg/cm2 force is exerted at each point Wolfe 1990).

The main aims of therapy are to reduce symptoms, to improve function, and to help patients adapt to the condition (Hauser 2008). Treatments include cognitive behavioural therapy and medication such as simple analgesics or NSAIDs, tramadol, antidepressants (low-dose tricyclics or antidepressant doses of selective serotonin re-uptake inhibitors or serotonin-noradrenaline re-uptake inhibitors) and antiepileptics (e.g. gabapentin, pregabalin).

Wolfe F et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990; 33: 160-72.

How acupuncture can help

Western-based systematic reviews of acupuncture for fibromyalgia are dependent on rather few, rather small, randomised trials in which the verum treatment has been compared to a sham version of acupuncture. Given that the sham interventions are not inactive placebos, but effectively different versions of acupuncture, it is not surprising that most reviews have not found acupuncture to be superior. The most recent (Langhorst 2010), with more trials included, reported acupuncture to have a significantly better analgesic effect than sham (though it was not superior for other symptoms). Another recent review, with access to the Chinese literature, was able to assess the effectiveness of acupuncture against conventional medication, as well as against sham (Cao 2010). This found it to be better than drugs in terms of pain relief.

Acupuncture may have the greatest benefit when applied together with medication or other therapeutic options (Targino 2008, Jang 2010). Further trials are needed, of larger size and with sounder methodology, and especially those that compare acupuncture to existing conventional interventions. [See Table below]

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety (Wu 1999).

stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz 1987, Zhao 2008);

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